Gonorrhea

Topic Overview

What is gonorrhea?

Gonorrhea is
an infection spread through sexual contact. In men, it most often infects the
urethra. In women, it usually infects the urethra,
cervix, or both. It also can infect the rectum, anus,
throat, and pelvic organs. In rare cases, it can infect the eyes.

Gonorrhea does not cause problems if you treat it right away. But if it's
left untreated, it can lead to serious problems.

What causes gonorrhea?

A certain kind of bacteria
causes gonorrhea. Gonorrhea is a
sexually transmitted infection, or STI. This means it
can spread from one partner to another during vaginal, anal, or oral
sex.

A woman who is pregnant can pass the infection to her newborn
during delivery.

What are the symptoms?

Many people have no
symptoms, so they can pass gonorrhea to their sex partners without knowing
it.

If there are symptoms, they may include:

Pain when you urinate.

Abnormal discharge from the penis or
vagina.

Gonorrhea infection in the throat also usually does not
cause symptoms.

Symptoms in men usually are easier to notice than
symptoms in women. But some men have mild or no symptoms.

In women,
the early symptoms may be so mild that they are mistaken for a
bladder infection or a vaginal infection. When an
untreated infection moves into a woman's pelvic organs, symptoms can include
lower belly pain, pain during sex, vaginal bleeding, and a fever.

The time from exposure to gonorrhea until symptoms begin usually is 2 to
5 days. But it may take as long as 30 days before symptoms start.

You can spread gonorrhea even if you don't have symptoms. You are
contagious until you have been treated.

How is gonorrhea diagnosed?

Your doctor will ask
you questions about your past health and your sexual history, such as how many
partners you have. Your doctor may also do a physical exam to look for signs of
infection.

Urine or fluid from the infected area will be tested for
gonorrhea. You may also be tested for other sexually transmitted infections
(STIs) at the same time. Testing can be done with a Pap test.

As soon as you find out you have
gonorrhea, be sure to let your sex partners know. Experts recommend that you
notify everyone you've had sex with in the past 60 days. If you have not had
sex in the past 60 days, contact the last person you had sex with.

How is it treated?

Antibiotics are
used to treat gonorrhea. It's important to take all of the medicine as
directed. Otherwise the medicine may not work. Both sex partners need treatment
to keep from passing the infection back and forth.

Getting
treatment as soon as possible helps prevent the spread of the infection and
lowers your risk for other problems, such as pelvic inflammatory
disease.

Many people who have gonorrhea also have
chlamydia, another STI. If you have gonorrhea and
chlamydia, you will get medicine that treats both infections.

Avoid
all sexual contact while you are being treated for an STI. If your treatment is
a single dose of medicine, you should not have any sexual contact for 7 days
after treatment so the medicine will have time to work.

Having a
gonorrhea infection that was cured does not protect you from getting it again.
If you are treated and your sex partner is not, you probably will get it
again.

Finding out that you have an STI may make you feel bad about
yourself or about sex. Counseling or a support group may help you feel
better.

How can you prevent gonorrhea?

It's easier to
prevent an STI like gonorrhea than it is to treat it.

Use a condom every time you have sex. Latex
and polyurethane condoms keep out the viruses and bacteria that cause
STIs.

Don't have more than one sex partner at a time. The safest
sex is with one partner who has sex only with you. Every time you add a new sex
partner, you are being exposed to all of the diseases that all of that person's
partners may have.

Be responsible. Don't have sex if you have
symptoms of an infection or if you are being treated for an
STI.

Wait to have sex with a new partner until both of you have
been tested for STIs.

Cause

Gonorrhea is spread during vaginal, anal, or oral sex with an infected
partner. A pregnant woman may pass the infection to her newborn during
delivery.

Gonorrhea can be transmitted at any time by a person who is
infected with the bacteria Neisseria gonorrhoeae,
whether or not symptoms are present. A person who is infected with gonorrhea is
always contagious until he or she has been treated.

Having a
gonorrhea infection once does not protect you from getting another infection in
the future. A new exposure to gonorrhea will cause reinfection, even if you
were previously treated and cured.

Symptoms

It is fairly common for
gonorrhea to cause no symptoms, especially in women.
The incubation period, the time from exposure to the bacteria until symptoms
develop, is usually 2 to 5 days. But sometimes symptoms may not develop for up
to 30 days.

Gonorrhea may not cause symptoms until the infection
has spread to other areas of the body.

Symptoms in women

In women, the early symptoms are
sometimes so mild that they are mistaken for a
bladder infection or vaginal infection. Symptoms may
include:

Symptoms in men

In men, symptoms are usually
obvious enough that they will cause a man to seek medical treatment before
complications occur. But some men have mild or no symptoms and can unknowingly
transmit gonorrhea infections to their sex partners. Symptoms may
include:

Abnormal discharge from the penis (clear or
milky at first, and then yellow, creamy, and excessive, sometimes
blood-tinged).

Complications of untreated gonorrhea in other areas of the body

Disseminated gonococcal infection (DGI) occurs when the
gonorrhea infection spreads to sites other than the
genitals, such as the joints, skin, heart, or blood. Complications of
DGI
include:

Fever.

Skin infection (cellulitis).

An infection in the
bloodstream (sepsis).

Inflammation of a joint (arthritis). It most often affects the knees and
hands.

An infection and inflammation of the heart valves and the
chambers of the heart (endocarditis).

An infection
of the fluid and tissues that surround the brain and spinal cord (meningitis).

Because many women do not have early symptoms of
gonorrhea that cause them to seek treatment, they are more likely than men to
have more serious complications from gonorrhea spreading to other parts of the
body.

Having a gonorrhea infection once does not protect you
from getting another infection in the future. A new exposure to gonorrhea will
cause reinfection, even if you were previously treated and
cured.

What Increases Your Risk

Risk factors for getting
gonorrhea include:

Having multiple sex partners (more than one sex
partner in the past year).

Having a high-risk partner (partner has
other sex partners, unprotected sex, or gonorrhea-infected sex
partners).

Having unprotected sexual contact (not using condoms).

Any child with gonorrhea needs to be evaluated by a doctor
to find out the cause and to assess for possible sexual abuse.

When To Call a Doctor

Gonorrhea
causes no long-term problems if it is treated early in the course of the
infection before any complications develop. Untreated gonorrhea can lead to
many complications.

In women:

Call your doctor immediately if you have the following symptoms.

Sudden, severe pain in the lower
belly

Lower belly pain with vaginal bleeding or discharge and a
fever of 100°F (38°C) or
higher

Urinary burning, frequent urination, or inability to
urinate and a fever of
100°F (38°C) or higher

Call your doctor to find out when an evaluation is
needed if you have the following symptoms.

Vaginal discharge that has become yellowish,
thicker, or bad-smelling

Bleeding between periods that occurs more
than once when periods are usually regular

Pain during sexual
intercourse

Bleeding after sexual intercourse

Sores, bumps, rashes, blisters, or warts on or around the
genital or anal area

Call your doctor or clinic if you have unprotected sex
with someone who has, or who you think may have, a sexually transmitted
infection.

Watchful waiting

Watchful waiting is a period of time during
which you and your doctor observe your symptoms or condition without using
medical treatment. Watchful waiting is not appropriate for a gonorrhea
infection. Gonorrhea causes no long-term problems if it is treated early in the
course of the infection before any complications develop. But untreated
gonorrhea can lead to many complications. Avoid sexual contact until you have
been examined by your doctor so that you will not infect someone else.

If you know you have been exposed to gonorrhea, both you and your sex
partner(s) must be treated. You need treatment even if you don't have symptoms.

As soon as you find out you have
gonorrhea, be sure to let your sex partners know. Experts recommend that you
notify everyone you've had sex with in the past 60 days. If you have not had
sex in the past 60 days, contact the last person you had sex with.

If you are unable to contact your sex partners or you are uncomfortable
doing so, health departments and sexually transmitted infection (STI) clinics can
help with this process.

Who to see

Low-cost diagnosis and treatment of gonorrhea is usually
available at local health departments and family planning clinics, such as
Planned Parenthood.

Some people are not
comfortable seeing their usual doctor for sexually transmitted infection
treatment. Most counties have confidential clinics for diagnosing and treating
gonorrhea and other sexually transmitted infections.

Exams and Tests

Diagnosis of
gonorrhea includes a medical history and a physical
exam. Your doctor may ask you the following questions.

Do you think you have been exposed to any
sexually transmitted infections (STIs)? How do you know?
Did your partner tell you?

What are your symptoms?

Do you have any discharge? If you have
discharge from your vagina or penis, it is important to note any smell or
color.

Do you have sores in your genital area or anywhere else on
your body?

Do you have any urinary symptoms, including frequent
urination, burning or stinging with urination, or urinating in small
amounts?

Do you have any unusual belly or pelvic pain?

What method of birth control do you use? Do you
use a condom to protect against STIs every time you have sex?

Do
you or your partner engage in
certain sexual behaviors that may put you at risk, such as having multiple sex partners or having sex without using a condom (except if you're in a long-term relationship)?

Several
gonorrhea tests can be used to detect or confirm an
infection. Your doctor will collect a sample of body fluid or urine to be
tested for gonorrhea bacteria (Neisseria gonorrhoeae).
Most tests give results within a few days.

Other sexually
transmitted infections may be present with a gonorrhea infection. Your doctor may
recommend testing for:

Chlamydia, a
bacterial infection of the
urethra in men, and the urethra, the
cervix, or the upper reproductive organs (or all
three) in women. Up to 40% of people who have gonorrhea also have
chlamydia.1

Syphilis, a bacterial infection in which the most
common symptom is a painless sore called a chancre (say "SHANK-er") that
develops on the genitals.

Hepatitis B, a
viral infection that causes the liver to become swollen and tender
(inflamed).

Human immunodeficiency virus (HIV), a
virus that attacks the immune system, making it difficult for the body to fight
off infection and some diseases.

In the United States, your doctor must report to the state health
department that you have gonorrhea.

Early detection

You may want to consider
being tested once a year for gonorrhea even though you don't have symptoms if you have increased risks for STIs. These include having multiple sex partners or having sex without using a condom (except if you're in a long-term relationship). Testing will allow gonorrhea to be quickly diagnosed and treated. This helps
reduce the risk of transmitting gonorrhea and avoid complications of the
infection.

The U.S. Centers for Disease Control and Prevention (CDC) also
recommends screening for pregnant women who engage in high-risk sexual
behaviors to prevent them from transmitting gonorrhea to their babies. If a
pregnant woman is at high risk for gonorrhea, she may be tested again during
the third trimester before delivery, to prevent transmitting the infection to
her newborn.3

Treatment Overview

Gonorrhea
causes no long-term problems if it is treated early in the course of the
infection before any complications develop. Untreated gonorrhea can lead to
many complications.

Initial treatment

Gonorrhea is
treated with
antibiotics. Treatment is
recommended for:

A person who has a positive gonorrhea
test.

Anyone who has had sexual contact in the past 60 days with a
person diagnosed with gonorrhea, whether or not they have symptoms or used
condoms.

A newborn whose mother has gonorrhea at the time of
delivery.

If you are prescribed more than one dose of an
antibiotic, be sure to take your antibiotic exactly as directed. If you miss
doses or don't take the full course of medicine, the gonorrhea infection may
not be cured.

Do not have sexual contact with anyone:

While you are being
treated.

Until both you and your partner(s) have been tested and
treated. If you are treated for gonorrhea and your sex partner is not, you will
probably become infected again.

If your treatment is a single dose of antibiotic, wait at
least 7 days after taking the dose before having any sexual contact.

Always use a
condom when you have sex. This helps protect you from
sexually transmitted infections.

Treatment if the condition does not get better

Symptoms that do not go away after treatment may be caused by another
gonorrhea infection or treatment failure.

Certain strains of the gonorrhea bacteria have become
resistant to some antibiotics, including quinolones,
penicillin, tetracycline, and sulfa drugs. When bacteria become resistant to an
antibiotic, they no longer can be killed by that medicine.3

If you have been treated for gonorrhea and
don't get better, you may be retested with a
gonorrhea culture to see if there is bacterial
resistance to the antibiotic you were taking. If there is bacterial resistance,
you will need another antibiotic to cure the infection.

What to think about

To prevent reinfection, don't
have sex until any partner that might be infected is tested and
treated.

Some people who have
gonorrhea also have
chlamydia. The U.S. Centers for Disease Control and Prevention (CDC) recommends that drug treatment for
gonorrhea also include antibiotics that are effective in treating chlamydia.
For more information, see the topic
Chlamydia.

Pelvic inflammatory disease (PID) is a serious
complication of gonorrhea that can lead to
infertility, chronic pelvic pain, and
ectopic pregnancy. To prevent PID, prompt treatment of
gonorrhea is important. For more information, see the topic
Pelvic Inflammatory Disease (PID).

Disseminated gonococcal infection (DGI) occurs when the
gonorrhea infection spreads to sites other than the
genitals, such as the joints, skin, heart, or blood. Treatment of
DGI usually
requires hospitalization and antibiotic treatment given
intravenously (IV) or into a muscle (intramuscularly,
IM).

In the United States, your doctor must report to the state health
department that you have gonorrhea.

Prevention

You can take measures to reduce your risk
of becoming infected with
gonorrhea or another
sexually transmitted infection (STI). You can also
reduce the risk of transmitting gonorrhea to your sex partner(s).

Practice safer sex

Talk with your partner about STIs before
beginning a sexual relationship. Find out whether he or she is at risk for an
STI. Remember that it is quite possible to be infected with an STI without
knowing it. Some STIs, such as
HIV, can take up to 6 months before they can be
detected in the blood.

Be responsible.

Avoid sexual contact if you have symptoms
of an STI or are being treated for an STI.

Avoid sexual contact
with anyone who has symptoms of an STI or who may have been exposed to an
STI.

Don't have more than one sexual relationship at a time. Your
risk for an STI increases if you have several sex partners at the same
time.

If you or your partner have had several sex partners
within the past year, or you are a man who has unprotected sex with men, talk
to your doctor about screening for gonorrhea and other STIs even if you don't
have symptoms.

Condom use

Condom use reduces the risk of becoming
infected with an STI, especially gonorrhea, chlamydia, and HIV. Condoms must be
in place before beginning any sexual contact. Use condoms with a new partner
every time you have sex, until you know from test results that he or she does
not have an STI. You can use either
male or female condoms.

Even if you are
using another birth control method to prevent pregnancy, you can use condoms to
reduce your risk of getting an STI. Female condoms are available for women
whose male partners do not have or will not use a male condom.

Home Treatment

There is no home treatment for
gonorrhea. It requires medicine prescribed by a doctor.

Prescription antibiotic medicine normally cures
gonorrhea infections. Gonorrhea does not cause
long-term problems if it is treated before any complications develop. But
gonorrhea can lead to many complications if it is not treated.

If
you have been diagnosed with gonorrhea:

Take the full course of antibiotics as
prescribed by your doctor. If you skip doses or do not complete the treatment,
the infection may not be cured.

Do not have sexual contact with
anyone while you are being treated. If your treatment is a single dose of
antibiotics, wait at least 7 days after taking the dose before having any
sexual contact.

Make sure your partner knows that he or she needs
to be treated even if there are no symptoms. You can spread the infection to
others even if you do not have symptoms.

Call your doctor if your
symptoms continue or reappear after treatment or if new symptoms develop. You
may need a different antibiotic medicine or further tests.

Finding out that you have gonorrhea may cause you to have
negative thoughts or feelings about yourself or about sex. Talking to a
counselor or joining a support group for people who have sexually transmitted
infections (STIs) may be helpful.

Medications

Antibiotics, if taken exactly as directed,
normally cure
gonorrhea infections. If antibiotics are not taken
properly, the infection will not be cured. Prompt antibiotic treatment also
prevents the spread of the infection and decreases complications, such as
pelvic inflammatory disease (PID).

Avoid
all sexual contact while you are being treated for a sexually transmitted
infection (STI). People taking a single dose of medicine should not have any
sexual contact for 7 days after treatment to give the medicine time to work.
Exposed sex partners need treatment whether they have symptoms or not.

What to think about

There is an increasing number of strains of gonorrhea that can't be killed by (are resistant to) certain antibiotics. If your doctor finds that your gonorrhea is resistant to
the drug you are taking, he or she might prescribe another antibiotic to cure
the infection. If you continue to have symptoms after you have been treated for
gonorrhea, you will need to be retested with a
gonorrhea culture to find out whether there is
bacterial resistance to the antibiotic you were taking.

Call your
doctor if symptoms continue or new symptoms develop 3 to 4 weeks after
treatment.

Treatment in a hospital with
intravenous (IV) medicines may be needed for women who
have pelvic inflammatory disease (PID) and men who have
epididymitis. In many cases, these conditions can be
treated outside of the hospital with oral antibiotics and close follow-up by
your doctor. For more information, see the topic
Pelvic Inflammatory Disease.

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